Claims Specialist at PMA Companies

North Las Vegas, Nevada, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Aug, 26

Salary

69000.0

Posted On

12 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Workers Compensation Claims, Claims Investigation, Case Resolution, Reserve Management, Claims Settlement, Medical Management, Litigation Management, Customer Service, Critical Thinking, MS Office, Regulatory Compliance, Subrogation Recovery

Industry

Description

As a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines. Responsibilities: * Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature * Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) * Alerts Supervisor and Special Investigations Unit to potentially suspect claims * Ensures timely denial or payment of benefits in accordance with jurisdictional requirements * Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure * Negotiates claims settlements within granted authority * Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition * Works collaboratively with Lodestar nurse professionals to develop and execute return to work strategies * Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome * Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced * Demonstrates technical proficiency through timely, consistent execution of best claim practices * Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues * Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account- specific sessions * Authorizes treatment based on the practiced protocols established by statute or the Lodestar Managed Care department * Assists Lodestar clients by suggesting panel provider information in accordance with applicable state statutes. * Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work. Qualifications * Must reside in NEVADA and have an NV license * Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required * Working knowledge of Workers Compensation regulations for NV jurisdiction. * Associate in Claims (AIC) Designation or similar professional designation desired * License required or ability to obtain license within 90 days of employment in mandated states * Familiarity with medical terminology and/or Workers' Compensation * Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously * Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details * Strong verbal, written communication skills and customer service skills gained through previous work experience * Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint * Ability to travel for business purposes, approximately less than 10%. Lodestar is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for this role is $53,000 to $69,000. Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within or below this range based on a variety of factors.

Responsibilities

Independently investigate, evaluate, and resolve complex Workers Compensation claims while ensuring compliance with legal statutes and company guidelines. This includes managing reserves, negotiating settlements, and collaborating with medical professionals for return-to-work strategies.